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may be an option. While Wegovy has been proven very effective for chronic weight management, it may come with a hefty price tag. That’s why it is essential to understand insurance coverage options as well as alternatives to insurance coverage. If you’re wondering if Wegovy is covered by insurance, or how to get Wegovy covered by insurance, we’ll have the answers for you.
Here’s what you need to know about insurance coverage for Wegovy.
What is Wegovy?
Wegovy (semaglutide) is a prescription weight loss medication approved by the Food and Drug Administration (FDA) for adults with obesity (BMI ≥ 30) or a BMI over 27 who also have at least one weight-related medical condition, such as type 2 diabetes or high blood pressure.
This once-weekly injection mimics the hormone glucagon-like peptide-1 (GLP-1), which targets areas of the brain that regulate appetite and food intake. One 68-week trial found that Wegovy users lost an average of 14.9% of their body weight throughout the trial.
As with many weight loss medications, you should combine Wegovy usage with a healthy diet and exercise for best results. And to minimize side effects, it’s recommended to start with a weekly dosage of 0.25 mg of Wegovy and work up to 2.4 mg over 17 weeks.
How to get Wegovy covered by insurance
Wegovy insurance coverage varies depending on your specific health plan. Many commercial and private insurers cover weight loss medications like Wegovy, or at least parts of it.
If you’re trying to get Wegovy or another GLP-1 medication covered by your health insurance, there are three important steps you can take:
- Talk to your healthcare provider: Before checking insurance coverage for Wegovy, you need to make sure the medication is suitable for you. Talk to your doctor about whether Wegovy is the right choice, based on your medical history and weight management needs. Once you get a prescription for Wegovy or another weight loss medication, such as Saxenda, you can look into insurance coverage
- Check in with your insurance provider: Contact your health insurance provider to determine whether your plan covers the medication. Make sure you also ask about your insurance plan’s out-of-pocket costs, and if prior authorization is needed. Before contacting your insurance provider, you can review your health insurance plan’s drug list (also known as a drug formulary), which you can find in your plan information.
- Don’t give up right away: If your insurance plan does not provide coverage for Wegovy, you may be able to request it with the help of your healthcare provider. Novo Nordisk offers a sample letter template they can use to request coverage.
Alternatively, an online weight loss program such as Ro Body Program has a dedicated insurance concierge partner who will work to find you coverage for Wegovy, if the medication is right for you. They will take care of communicating with your insurance company and even handle the paperwork.
Do Medicaid or Medicare approve Wegovy?
Each state determines which prescription drugs they will include as part of their Medicaid program. As a result, drug coverage for Medicaid beneficiaries varies depending on the state in which you live. Contact your state Medicaid agency to determine whether your state’s Medicaid program covers Wegovy.
As for Medicare, weight loss medications like Wegovy are usually not covered. However, you need to check your specific plan’s prescription medication coverage to find out for sure.
Wegovy cost with insurance vs. Wegovy cost without insurance
A package of Wegovy contains four pens, each pre-filled with a single dose of Wegovy, or about a month’s worth of the medication. Without insurance, the list price of Wegovy is $1,349.02 per package, which breaks down to $269.80 per week or $16,188.24 per year.
Your out-of-pocket cost with insurance depends on your insurance coverage. It’s important to include your prescription copay and deductible when determining how much your supply of Wegovy will cost after insurance covers their portion.
Regardless of your insurance plan, your provider may require prior authorization to receive coverage benefits. You may also need to try a less expensive weight loss medication before receiving approval for Wegovy.
Are there ways to save money on Wegovy?
Even without health insurance, there are ways to save on Wegovy and bring down the cost of Wegovy.
Wegovy savings card
With a Wegovy savings card by Novo Nordisk, the manufacturer of Wegovy, you can receive a 28-day supply of your prescription medication for as little as $0 if you have private or commercial insurance with prescription drug coverage. However, certain eligibility requirements and restrictions apply. If your insurance doesn’t cover it or you pay cash for your prescription medications, you can save up to $500 per 28-day supply. If your commercial or private health insurance covers Wegovy, you can save up to $200 per 28-day supply.
Prescription discount cards
Companies like GoodRx or SingleCare provide prescription discount cards or Wegovy coupons for Wegovy. For example, sites like GoodRx aggregate free Wegovy coupons that can be used at a variety of pharmacies — including Walgreens, CVS, and Walmart — enabling people to save between 7% to 34% on the retailer’s price. You can also talk to your pharmacist about prescription discount cards they may offer at the pharmacy.
Compare pharmacy prices
Prescription drug prices can vary from pharmacy to pharmacy. To find the lowest price, call several local pharmacies and ask what their retail price is for Wegovy. If you plan to use your insurance, you may need to show the pharmacy your prescription and insurance card before they can provide a price.
If you have insurance, but they don’t offer coverage for Wegovy, you can still compare pharmacy prices to find the best deal near you. Ask your pharmacist to run the cash price of Wegovy through the various pharmacy discount programs to find the lowest price.
Ozempic manufacturer assistance program
If you also have diabetes, you might qualify for the Novo Nordisk Patient Assistance Program (PAP). This program provides eligible patients with access to free diabetes medicine, which may include Ozempic (semaglutide; see Important Safety Information). Ozempic injections deliver the same medication as Wegovy but in smaller doses (0.25, 0.5 mg, and 1.0 mg).
Talk to your healthcare provider about whether Ozempic is an option for you. Your care team will help determine the best treatment options and help you apply to the Novo Nordisk PAP if you qualify.
Ultimately, finding out whether your insurance plan covers Wegovy and how much it’ll cost comes down to reaching out to your insurance provider directly. But, even if they don’t cover it, the tips above may help you save money on this medication.
What are the side effects of Wegovy?
Just like most prescription drugs, Wegovy may cause side effects that range from mild to severe. In clinical trials, nausea, vomiting, and diarrhea were the most common side effects.
Other common side effects of Wegovy include:
Potentially serious side effects of Wegovy may include:
- Severe allergic reaction
- Increased heart rate
- Low blood sugar
- Low blood pressure
- Inflammation of the pancreas (pancreatitis)
- Gallbladder problems
- Kidney problems
- Diabetic retinopathy
If you experience any of these serious side effects, contact your healthcare provider immediately. They may alter your medication dosage or change your care plan altogether to help reduce the severity of your side effects.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
- GoodRx. (2022). Wegovy prices, coupons & savings tips. Retrieved from https://www.goodrx.com/wegovy
- SingleCare. (2022). Wegovy coupons & prices. Retrieved from https://www.singlecare.com/prescription/wegovy
- U.S. Food and Drug Administration (FDA). (2021). Highlights of Prescribing Information Wegovy (semaglutide) injection. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf
- Wegovy.com. (2021). Wegovy coverage and savings. Retrieved from https://www.wegovy.com/coverage-and-savings/wegovy-savings-and-support.html
- Wilding, J. P. H., Batterham, R. L., Calanna, S., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33567185
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.